Published 6:30 am, Tuesday, February 20, 2007

Forty years ago, admission to a psychiatric hospital often meant admission of despair. A Houston resident suffering a mental breakdown could be housed for years in a facility in Arkansas. That's how few the placement options were in these parts — and how weak the tools for treatment.

This scenario helps to explain the 1960s law banning Medicaid payments for stand-alone psychiatric hospitals. Stays were too long and medical success too rare for Medicaid to fund.

Now revolutions in medication, brain science and understanding of mental illness have transformed that landscape. It's urgent that Congress acknowledge these tectonic changes — and swiftly update the Medicaid rule now creating chaos in Harris County.

Why the sudden sense of crisis over a law established 40 years ago? Until this year, Harris County had a waiver that allowed companies to use Medicaid funds to pay for hospital care at psychiatric facilities. But in January, Medicaid ended managed care's role in paying hospitals.

On Feb 1, Medicaid stopped reimbursing free-standing psychiatric hospitals for inpatient care. The cutoff hits all of Houston's six psychiatric hospitals, which treat an estimated 75 patients every day.

In all, the cutoff will whisk away 85 psychiatric beds in Harris County. The outcome, mental health advocates, psychiatric and surgical hospitals say, is nothing short of disastrous.

The cutoff comes at a time when successes — and needs —for treating mental health have never been greater. Timely professional treatment can return patients with major illnesses to their families and former lives, and it does so in much less time: Area mental hospitals treat their inpatients an average of eight days.

Yet even before the Medicaid cutoff, 76,000 adults with severe mental illness were unable to get the treatment they needed in 2005, according to the Mental Health Needs Council. For those patients unable to get access to treatment, prospects may be as bleak as they were back in the 1960s.

The situation is cruel and dangerous. Because many untreated sufferers will end up in jail, the Medicaid law burdens local taxpayers with the expense and occasional danger of picking up where mental hospitals were forced to leave off.

According to state officials, stand-alone psychiatric hospitals are for Medicaid. The federal government, though, says past payments through managed care violated Medicaid policy and can't continue.

In the end, sorting through the nuances of legislation from another era misses the point. The effectiveness and need for mental health care can't be disputed. Medicaid exists to make sure poor Americans get health care to keep both them and those around them safe. Mental health is part of that compact.

Congress needs to update its Medicaid provision for psychiatric hospitals immediately. Until it does, many Harris County residents run risks that properly belong in the last century.